amfAR’s Opioid and Health Indicators Database

In the wake of the dramatic 2015 outbreak of HIV and hepatitis C among people who used drugs in Scott County, Indiana, the CDC created a report that showed 220 other counties vulnerable for similar outbreaks. That report was the genesis for a more granular and interactive database, Opioid and Health Indicators Database, which amfAR built in 2016. The goal was to provide local and national statistics on new HIV and hepatitis C infections, opioid use, overdose death rates, and the availability of services like drug treatment and syringe services programs. Users can see geographic differences in how the opioid epidemic has impacted states and counties over time across the U.S. And they can see epidemiological data like drug use, drug related mortality, as well as health and harm reduction services.

What jumps from the database is, not surprisingly, a mismatch between risk factors and the amount of services available. For example, ninety-three percent of communities determined to be vulnerable to outbreaks of HIV and hep C due to IV drug use don’t have a syringe exchange program. And syringe exchange programs are not legal in every state.

HIV and hep C diagnoses from injection of synthetic opioids like fentanyl and heroin more than tripled from 2010 to 2015. According to the CDC, every twenty-four hours, nearly 100 Americans die from a drug overdose.

Alana Sharp, a policy associate at amfAR, said she hopes that, in addition to helping communities and advocates make more informed decisions to respond to the opioid epidemic, the database will help policymakers—especially the ones holding the purse strings—devote more resources to the crisis.

“We need more federal funding for this crisis,” she says. “But Congress has not appropriated any new money since Trump took office. States can repurpose federal grant money but they must divert that money from other services.”

In 2017 the federal government doled out approximately $500 million, authorized under former President Obama, to states to combat opioid abuse. Another half million appropriated under Trump is being held up in a budget battle on Capitol Hill.

So far the amfAR database has been cited in state lawsuits in Alabama, Massachussetts and Pennsylvania, against pharmaceutical companies. In addition, the database was shared by HIVMA to its membership as a talking-points tool for legislators around opioids, HIV, and other issues. And the database was cited by the American Psychological Association and the National Association of Social Workers in a letter to the Subcommittee on Labor-HHS-Education, which encouraged support for SAMHSA’s Center for Mental Health Services (CMHS).

An emergency without urgency
Sharp acknowledged that the amfAR database could be used to lobby for more money and more risk reduction policies, but that it was up to lawmakers, policymakers, and public health officials to do the advocating.

Sharp and other opioid policy advocates say the federal response under Trump has been inadequate to meet the enormity of the crisis.

In October 2017, the Department of Health and Human Services declared the opioid crisis a Public Health Emergency, which was extended for another ninety days in January. The designation allowed federal health agencies to hire more treatment specialists, and it opened up access to the Public Health Emergency Fund. But that fund has a balance of just $57,000, and the administration hasn’t promised to replenish it. Acting HHS secretary Eric Hargan said in November that Trump would let Congress decide whether more money should be appropriated.

Public health officials have complained that the emergency declaration has so far produced little direct action. And in January, the Trump administration’s effort to combat drug abuse suffered an embarrassing setback when Taylor Weyeneth, the 24-year old deputy chief of staff of the Office of National Drug Control Policy, or ONDCP, which coordinates federal drug-control efforts, resigned amid a controversy over his flimsy job record.

Early last year, Trump launched a commission to study the opioid crisis, headed by New Jersey Gov. Chris Christie. In November, that commission produced a final opioid plan, with more than fifty different recommendations for combatting the opioid crisis. But that report was only part of what’s needed, Sharp said.

“We need more focused and actionable plan for how to respond to the crisis. So far the administration has not acted on the commission’s recommendations, and the report does not mention anything about syringe exchange.”

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